Health in Ireland Key Trends 2016
This is the ninth edition of this easy-to-use reference guide to significant trends in health and health care over the past decade, including population and health status, as well as trends in service provision. This year, new tables, maps and graphs have been included on some specific topics or where new data has been made available. Each section has a brief introduction summarising key statistics.
Health in Ireland Key Trends 2016
Key trends include:
- Total hospital discharges continue to rise with 62.1% of this activity now carried out on a day case basis (including dialysis). There has been a 55.0% increase in the number of day cases seen in public acute hospitals since 2006. Improved and less invasive medical practice is largely responsible for the rapid growth in day patient activity.
- Over the past decade, Ireland has achieved a rapid improvement in life expectancy. Life expectancy in Ireland has increased by almost two and a half years since 2005 and has been consistently higher than the EU average throughout the last decade.
- Much of this increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases and cancer. Since 2006 there has been a reduction in mortality rates for most major causes. The overall mortality rate has reduced by 16.7% since 2006.
- Ireland is now beginning to catch up with other European countries in terms of population ageing. The population of those aged 65 years and over has increased by 32.8% since 2007 and has been increasing at a faster rate than that of our EU neighbours. The numbers of people in this age group is expected to almost double in the next 20 years, with the greatest proportional increase in the 85+ age group.
- The number of live births has falling year-on-year since 2009 and in 2015 the number of registered births was 65,909. Despite reductions in the numbers of births in recent years, the fertility rate in Ireland remains the 2nd highest in the EU behind France.
- In comparison to other EU countries, Ireland continues to have the highest levels of self-perceived health of any EU country. Those with higher education attainment tend to report better health than those with lower education attainment.
- There has been significant improvement in survival rates from breast and colorectal cancer in the last 15 years. However, 5-year relative survival rates from breast and cervical cancers are lower in Ireland than the average for OECD countries where data is available. The survival rate in Ireland for colorectal cancer is slightly lower than the OECD average.
- While there has been a reduction in the mortality rate from respiratory diseases (including cancer of the trachea, bronchus and lung) of almost 3.6% since 2010 the rate in Ireland is 40.3% higher than the EU28 average.
- From 2006 to 2014 the average length of stay decreased by 12.1%. In 2015 there was a slight increase in length of stay of 2.2%.
- The number of day case discharges in acute hospitals per 1,000 population has increased significantly over the period 2006 to 2015, while the number of in-patient discharges per 1,000 population has remained relatively stable.
- In terms of elective procedures for adults waiting more than 8 months there has been an increase in the numbers waiting over the period December 2015 to October 2016, with a slight decrease in November 2016. For children waiting more than 20 weeks the number waiting for elective procedures increased throughout the year.
- The total number of people on outpatient waiting lists increased in the period December 2015 to August 2016, with the number increasing at a slower pace from August 2016 to November 2016. The number of people waiting longer than 52 weeks increased throughout the year.
- The 30-day moving average of the number of admitted patients on trolleys in emergency departments has seen a seasonal decrease for much of 2016 compared to 2014 and 2015, with an increase seen in the last 2 months of 2016 however.
- Between 2006 and 2015 there was an increase of 29.9% in the number of medical cards to 1.73 million. Numbers of GP only visit cards in 2015 increased significantly to just over 430,000, though it should be noted that this is largely due to the introduction of GP visit cards to all children under 6 in 2015.
- The numbers of people employed in the public health service now stands at 105,886 (September 2016). This is a 1.9% increase from the numbers employed in the public health service at the end of 2015.
- Total public health expenditure has risen from €13.7 billion in 2007 to an estimated €15 billion in 2016. Estimates for 2016 indicate a 4.8% increase in expenditure from 2015.
Further key trends, by section of the booklet, are presented below:
Section 1 – Population and Life Expectancy
Provisional data from Census 2016 show an overall increase of nearly 4% in the total population since the last Census in 2011 but a significant slowdown in growth over the period. As population data by age is not yet available from Census 2016 the CSO population estimates for 2016 are used in Key Trends 2016.
- The population in 2016 was estimated at 4,673,700. This is an increase of 2.2% on the 2011 Census of Population. There has been a 6.8% increase in population since 2007, with the largest % change in the over 65 age groups (Tables 1.1 and 1.2).
- Counties in the west and north-west of Ireland have a greater proportion of people aged 65 and over (Figure 1.1).
- The total population in Ireland has increased more rapidly than the EU average in the last decade; however the increase has been modest since 2010. The population aged 65 and over has increased at a greater rate than the population as a whole, and at a greater rate than the EU average for those aged 65 and over (Figure 1.2).
- The numbers of births in 2015 have shown a 2.1% decrease on the previous year, with 65,909 births being registered in the year. The number of live births has fallen year on year since 2009 (Table 1.3).
- The Total Fertility Rate has decreased slightly in recent years and now stands at 1.94. However, Ireland has the 2nd highest rate of fertility amongst EU countries behind France. The EU average fertility rate in 2014 was 1.58 (Table 1.3 and Figure 1.4).
- In 2015, counties Kerry, Kilkenny and Dublin had the lowest fertility rates (Figure 1.3).
- The number of people in older age groups is beginning to increase significantly. The numbers of people over the age of 65 years is projected to almost double to around 1.1 million by 2036. The greatest proportional increase will be in the 85+ age group (Table 1.4, Table 1.5 and Figure 1.5).
- The rate of proportional growth in those aged 65 and over in Ireland is higher than the EU average, but the actual and projected percentage of population aged 65 and over is lower in Ireland than the EU average (Figure 1.6).
- Life expectancy at birth for women in Ireland was 4.2 years longer than for men in 2014; this is a reduction of this difference which was 5.5 years in 1994 (Table 1.6).
- Life expectancy at birth in Ireland is slightly above the EU average and, although the life expectancy at birth for women in Ireland has matched the EU average for women over the past decade, the life expectancy at birth for men in Ireland has been consistently greater than that of the EU average (Figure 1.7, Figure 1.8).
- Although women have a higher life expectancy than men, when life expectancy is expressed as years lived in good health (i.e. healthy life years) at age 65, the difference between women and men is less significant, indicating that women live longer but with more health problems (Figure 1.9).
Chapter 2 – Health of the Population
Please note that any references below to 2015 mortality data should be considered provisional as 2015 data in this report are based on year of registration, and not year of occurrence.
- In 2014, 83.2% of males and 81.9% of females rated their health as being good or very good. This is the highest in the EU and compares with an average of 70.4% and 64.8% for males and females respectively across the EU. Those with higher educational attainment report being in better health (Table 2.1, Figure 2.1, Figure 2.2).
- 52.9% of males and 53.5% of females aged 65 and over reported suffering from a chronic illness or health problem. In the 75+ age category, 42.8% and 50.2% of males and females respectively reported some or severe limitation in usual activities due to health problems (Table 2.2, Table 2.3).
- Over the 10 year period 2006-2015, age-standardised death rates for all causes fell by 16.7% (Table 2.4).
- Among those aged 65 years and over diseases of the circulatory system accounted for 33.4% of all deaths registered in 2015. This compares with 19.9% of deaths of those aged less than 65 years (Table 2.4, Figure 2.3a and Figure 2.3b).
- Deaths from respiratory diseases (including cancer of the trachea, bronchus and lung) accounted for 20.2% of all deaths to those aged 65 and over and 12.0% of all deaths of those aged under 65 (Figure 2.3a and Figure 2.3b).
- There has been a 12.8% decline in the age-standardised death rate for cancer in the last decade, more recently there has been a decrease of 5.2% between 2014 and 2015. The female breast cancer death rate has declined by 9.4% since 2014 (Table 2.4).
- Death rates from suicide are down 5.6% since 2006 and have decreased by 7.4% between 2014 and 2015 (data for 2015 are provisional) (Table 2.4).
- The 5-year age-standardised death rates from respiratory system diseases (including cancer of the trachea, bronchus & lung) (2011-2015) are highest in counties Longford, Limerick and Carlow (Figure 2.4).
- Ireland’s age-standardised death rate in 2013 was above the EU average, though not significantly. The death rate from respiratory diseases (including cancer of the trachea, bronchus and lung) was 40.3% above the EU average (Table 2.5).
- The age-standardised death rates for cancer (excl. trachea, bronchus and lung), circulatory system diseases, ischaemic heart disease and respiratory system diseases (incl. cancer of the trachea, bronchus and lung) have all decreased over the previous 15 years (1999-2015) (Figure 2.5).
- The 3-year moving average of the age-standardised death rate due to suicide in Ireland has risen slightly over recent years and is now the same as that of the EU average. The 3-year moving average of the age-standardised death rates due to transport accidents in Ireland has continued to fall over the period 2013 to 2015 and has been consistently lower than the EU average (Figure 2.6).
- Ireland has had a lower infant mortality rate than the EU average over the last decade; however the gap has narrowed in recent years (Figure 2.7).
- There has been significant improvement in survival rates from breast and colorectal cancer in the last 15 years. However, 5-year relative survival rates from breast and cervical cancers are lower in Ireland than the average for OECD countries where data is available. The survival rate in Ireland for colorectal cancer is slightly lower than the OECD average (Figure 2.8).
- The percentage of mothers breastfeeding on discharge from hospital has increased steadily in the last decade. In 2015, 58.0% of women breastfed at least partially (Figure 2.9).
- Cigarette consumption has declined over the past decade with only a slight increase seen in 2015, while alcohol consumption increased slightly in 2014 and remained steady in 2015. The official figures do not include purchases made outside the State or illegal imports into the State which may exaggerate the recent years’ decline. Cigarette consumption excludes ‘roll-your-own’ cigarettes (Figure 2.10).
- The highest percentage of current smokers is seen amongst males and younger age groups (Figure 2.11).
- The highest percentage of regular binge drinking, defined as drinking 6 or more units of alcohol at least once a month over a 12 month period, is seen amongst younger age groups. The percentage of regular binge drinkers in Ireland is slightly higher than the EU-25 average (Figure 2.12).
- The highest percentage of drug use in the last month is seen amongst males and younger age groups (Figure 2.13).
- Substance use amongst 15-16 year olds in Ireland in the previous 30 days prior to survey was lower than the EU average for cigarettes, alcohol and heavy episodic drinking, with only cannabis use being slightly higher than the EU average (Figure 2.14).
- A higher proportion of females than males eat 5 or more portions of fruit or vegetables per day, with older age groups eating less fruit or vegetables than the younger age groups (Figure 2.15).
Chapter 3 – Hospital Care
- Inpatient discharges from publicly funded acute hospitals have increased by 8.9% since 2006 (Table 3.1).
- From 2006 to 2014 the average length of stay decreased by 12.1%. In 2015 there was a slight increase in length of stay of 2.2% (Table 3.1).
- The number of acute beds for in-patients has fallen to 10,473 in 2015, a reduction of 13.5% since 2006. The number of beds for day cases has risen to 2,026 in 2015, an increase of 42.9% since 2006 (Table 3.1).
- The number of day cases has risen to 1,025,797 in 2015, an increase of 55.0% compared to 2006. There has been an increase of 16.1% in the number of day cases as a percentage of total discharges (in-patient and day cases) in the period 2006-2015 (Table 3.1).
- The number of day case discharges in acute hospitals per 1,000 population has increased significantly over the period 2006 to 2015, while the number of in-patient discharges per 1,000 population has remained relatively stable (Figure 3.1).
- In terms of elective procedures for adults (waiting more than 8 months) there has been an increase in the numbers waiting over the period December 2015 to October 2016, with a slight decrease in November 2016. For children (waiting more than 20 weeks) the number waiting for elective procedures increased throughout the year (Figure 3.2).
- The total number of people on outpatient waiting lists increased in the period December 2015 to August 2016, with the number remaining relatively steady from August to November 2016. The number of people waiting longer than 52 weeks increased throughout the year (Figure 3.3).
- The 30-day moving average of the number of admitted patients on trolleys in emergency departments has seen a seasonal decrease for much of 2016 compared to 2014 and 2015, with an increase seen in the last 2 months of 2016 however (Figure 3.4).
- People in older age groups utilise health services more (day patient and in-patients services or consultant visits) in comparison to younger age groups. For emergency departments visits there is more equal distribution of attendances across all age groups with 15-24 year olds most likely to attend (Figure 3.5).
- 266 transplants were carried out in Ireland in 2015, with kidney transplants being the most common (Figure 3.6 and Figure 3.7).
- The number of admissions to psychiatric hospitals and units has decreased over the period 2006 and 2015, with 12.0% fewer admissions in 2015 than in 2006. The admission rate per 100,000 population has fallen by 19.6% over the period 2006 to 2015 (Table 3.2, Figure 3.8).
Chapter 4 – Primary Care and Community Services
- The percentage of the population with a medical card is higher in 2016 compared to 2007 across all age groups except for those aged 65 and over (Figure 4.1).
- The north-western, northern and south-eastern counties had the highest percentage of population with medical cards (Figure 4.2). NOTE: data in the map are presented by Local Health Office areas.
- 37.4% of the population had a medical card at the end of 2015. This compares with 28.8% in 2006 (Table 4.1).
- Between 2014 and 2015 there was a decrease (1.9%) in the number of medical cards to 1.73 million. Numbers of GP only visit cards in 2015 increased significantly to just over 430,000, though it should be noted that this is largely due to the introduction of GP visit cards to all children under 6 in 2015 (Table 4.1).
- The number of people registered for the Drugs Payments Scheme has declined 2.3% between 2014 and 2015 (Table 4.1).
- The numbers of people on the Long-Term Illness Scheme has increased by 112.2%, or over 119,000 people, since 2006 (Table 4.1).
- The number of people treated under the dental and ophthalmic schemes has risen by 62.7% and 63.6% respectively between 2006 and 2015 (Table 4.1).
- The number of prescription items dispensed, and the average cost per item, under the General Medical Services have both decreased by just over 2% between 2014 and 2015 (Figure 4.3).
- There has been a slight reduction in the percentage of people covered by private health insurance in 2015 compared to 2011; this is the case for all age groups with the exception of those aged 70 and over where there has been an increase in the percentage of people covered (Figure 4.4).
- The number of beds available in long-term care units covered by the nursing homes support scheme has increased by 8.2% over the period 2013 to 2015. The proportion of patients aged 85+ in long term care has increased slightly over the period 2013 to 2015, with just over half of all patients in long term stay units in 2015 aged 85+ (Table 4.2, Figure 4.5).
- The immunisation uptake rates of children aged 24 months in 2015 was 95% for most immunisations, with the exception of the MMR, Meningococcal and Pneumococcal Conjugate vaccines (Table 4.3).
- The number of people registered with the National Physical and Sensory Disability Database was 22,813 in 2015, with 49.0% of these having a physical disability only (Table 4.4).
- The number of persons with an intellectual disability availing of day services has increased by 23.6% over the period 2006-2015 with a 22.3% increase seen in those availing of these services as day attendees only, compared to a fall of 4.3% in full time residents availing of the services (Table 4.5).
- The number of cases in treatment for problem drug use has increased by 45.5% during the period 2006-2015, with an increase of 1.0% in 2015 over the numbers in treatment in 2014 (Table 4.6).
Chapter 5 – Health Service Employment
- Over the period 2007 to 2014 total numbers employed in the public health services have shown a gradual decline, however in recent years this number has started to increase. There were 105,886 wholetime equivalents employed in September 2016; this represents an increase of 1.9% since December 2015 and 6.6% higher than in December 2014. It should be noted that figures for 2016 refer to September, and do not therefore represent the end of year position (Table 5.1, Figure 5.1).
- All grade categories have shown an increase between December 2015 and September 2016 except for general support staff (Table 5.1).
- Nurses make up the largest grade category in the public health service, with 33.6% of total staff employed (Figure 5.2).
- The number of consultants employed by the public health service increased by 26.5% in the period 2007-2016. They also increased by 3.7% between December 2015 and September 2016 (Table 5.2, Figure 5.3).
- The number of non-consultant hospital doctors increased by 21.1% in the period 2007-2015. They also increased by 2.9% between December 2015 and September 2016 (Table 5.2, Figure 5.3).
- There were 2.8 practicing doctors per 1,000 population in Ireland in 2014. This is below the OECD28 average of 3.3 (Figure 5.4).
Chapter 6 – Health Service Expenditure
- Total public expenditure on health has increased by 9.4% since 2007, with an increase of 4.8% between 2015 and 2016 (data for 2016 are estimates) (Table 6.1, Figure 6.1).
- HSE non-capital total allocation has increased by 18.5% in the period 2009-2015, with an increase of 5% in the period 2014-2015. Acute hospitals accounted for 33.8% of HSE non-capital expenditure in 2015 (Table 6.2, Figure 6.2).
- Public capital expenditure on health increased 3.1% between 2014 and 2015 and decreased by 13.7% since 2006 (Table 6.3).
- According to the System of Health accounts (SHA) methodology, Ireland’s current total (public and private) health expenditure was estimated to be €19.1 billion in 2014. The largest financing scheme in Ireland is the Government financing schemes and compulsory contributory health care financing schemes, accounting for 69% of all finance in health care expenditure. Curative and rehabilitative care accounted for 54% of all health care expenditure, and hospitals accounted for 35% of total current health care expenditure (Table 6.4, Table 6.5 and Table 6.6).
- Total health expenditure in Ireland per capita in real terms (adjusted for inflation) has shown an overall increase over the period 2005-2015 (Figure 6.3).
- In terms of health expenditure per capita, Ireland ranks as the 8th highest spend amongst selected OECD countries, and 11th highest in health expenditure expressed as a percentage of GDP (Table 6.7).
- The percentage breakdown of health expenditure by health provider according to the System of Health accounts methodology for Ireland is shown in Figure 6.4.